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GOP leaders don't need a full repeal of the ACA; they can begin to dismantle it immediately. Republicans lawmakers are exploring how the Trump administration can quickly trim the law's essential health benefits requirement, GOP Congressional aides told Bloomberg. However, some experts note that cutting certain benefits, such as mental-health coverage, may not be politically feasible. Other options the administration could take quickly include narrowing how and when people can sign up for coverage. (Bloomberg )


Seema Verma, tapped to run CMS, designed a Medicaid expansion in Republican Indiana that requires recipients to make monthly payments. That could be her approach when she takes office, NPR reports. "She's very committed to extending coverage to low-income families" and very focused on personal responsibility, says Cindy Mann, the CMS official who negotiated with her on Indiana's expansion. But one person's "personal responsibility" is another's barrier. Joe Thompson, CEO of the Arkansas Center for Health Improvement, argues the "social stresses of low-income individuals probably make most aspects of managing through the day more difficult" than for the more affluent. (NPR )

Congressional Republicans might win their lawsuit that challenges health insurance subsidies, and that could leave them in an awkward position, The New York Times reports. A sudden loss of subsidies could "cause the health care program to implode, leaving millions of people without access to health insurance before Republicans have prepared a replacement." The result: chaos in the insurance market. To avoid this, Republicans might need to appropriate funds to temporarily prop up the ACA, angering conservative voters. ( The New York Times )

CMS should improve provider support and develop health IT backend systems to ensure physicians are prepared for the Quality Payment Program (QPP), according to the Health and Human Service's Office of the Inspector General. "CMS has made significant progress towards implementing the QPP. Although many milestones remain before the QPP payment adjustments in 2019, OIG identified two vulnerabilities that are critical for CMS to address in 2017... (1) providing sufficient guidance and technical assistance to ensure that clinicians are ready to participate in the QPP, and (2) developing IT systems to support data reporting, scoring, and payment adjustment." (RevCycle Intelligence; OIG report )
Innovation & Transformation    
Providers and payers continue to bridge the "trust gap" by entering partnerships and collaborations.  FierceHealthcare recently profiled some of these partnerships. Among them is one between Moffitt Cancer Center in Florida and UnitedHealthcare; they created a new bundled payment to lower the costs of cancer care. For a three-year pilot project, the two organizations developed surgery and radiation therapy bundles focused on early stage lung cancer. (FierceHealthcare)

As more people travel to receive health care, more hotels are opening near hospitals. Some hospitals are opening their own lodging, FierceHealthcare reports. One example: The Cleveland Clinic leased land to a developer to open a hotel on its property--the Holiday Inn Cleveland Clinic. It's designed to accommodate patients, be they in wheelchairs or on respirators. A night's stay at the hospital could cost as much as $2,500; a night at the hotel runs $250 or less. Intercontinental Suites Hotel, also onsite, offers wellness programs to target medical tourists. (FierceHealthcare )
Consumers & Providers
When oral health is treated as if it were unrelated to overall health, the consequences can be dire. In this  Health Affairs essay, Gayathri Subramanian, an assistant professor at the Rutgers School of Dental Medicine, tells the story of a cancer patient who delayed needed dental care before radiation treatment because it was too costly, and then developed a painful, incurable disease. (Health Affairs; podcast)
 
 
CMS' Hospital-Acquired Condition Reduction Program "is broken," according to a blog post from the American Hospital Association. It cites a report in the  American Journal of Medical Quality in which the AHA and its research partners outline the failings. The research indicates the program disproportionately penalizes teaching and large urban hospitals and fails to adequately capture performance, especially for hospitals that care for patients with complex needs. (American Journal of Medical Quality; AHA blog post)
 
ICUs are being used too often for patients who don't need that level of care, according to research published in  JAMA Internal Medicine . The study found more than half the patients admitted to the ICU "were categorized into groups suggesting that they were potentially either too well or too sick to benefit from ICU care or could have received equivalent care in non-ICU settings," said Dong Chang, MD, an LA BioMed researcher and the study's corresponding author. "This research indicates that ICU care is inefficient because it is devoting substantial resources to patients who are less likely to benefit from this level of care [...] at a substantial cost." (Science Daily; JAMA Internal Medicine)
 
New & Noted   
Aetna/Humana deadline pushed back:  With the antitrust suit still not settled, Aetna and Humana have extended their merger deadline to Feb. 15, FierceHealthcare reports, citing an SEC filing. (Fierce Healthcare; filing )
Gray

Endocrinologists rethink obesity:  The American Association of Clinical Endocrinologists and the American College of Endocrinology introduced a new term for obesity--adiposity-based chronic disease. This frames it as a chronic disease and shifts the emphasis to the pathophysiological effects of excess weight. (Endocrine Practice
Gray

Obama's legacy: As part of its review of the Obama era, The New York Times offers an analysis of the Affordable Care Act, exploring Barack Obama's health care legacy and the ways in which the ACA has changed how U.S. health care is delivered, paid for and measured. (The New York Times) 
Multi-media  
In this interview with  MedPage Today , Mark McClellan, MD, PhD, director of the Margolis Center for Health Policy at Duke, discusses how Rep. Tom Price, MD (R-Ga.), will shape health care. He discusses how Price might approach Medicare, physician payment reform and rising prescription drug costs. Price will continue pursuing alternative payment models in Medicare, McClellan says, and he expects the CMS Innovation Center to stay in place, perhaps with greater emphasis on what works for smaller providers. (MedPage Today)
MarketVoices...quotes worth reading
 
"They don't feel like they have skin in the game. One guy told me that it feels like Indiana is trying to take his last $12."--Adam Mueller, a lawyer for Indiana Legal Services, on how his clients feel about the Indiana Medicaid program, speaking to  NPR 
 
"The cost-sharing policy is not to burden the individual. I think it's to incentivize them and empower them to be part of the equation."--Presumptive CMS chief Seema Verma, at a 2013 Congressional hearing, talking about Indiana's approach to Medicaid, quoted by NPR
 
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Wednesday, January 4, 2017